To explore both homocysteine (Hcy) and other risk factors for the recurrent stroke in patients with stroke and hypertension.

A total of 1623 hospitalized patients with stroke and hypertension recruited from Department of Neurosurgery, Affiliated Hospital of Xuzhou Medical University and Department of Cardiology, Xuzhou Central Hospital were analyzed. During a median follow-up period of 4.9 years, patients were divided into the recurrence group with 312 patients and the non-recurrence group with 1311 patients according to achieved follow-up recurrent stroke. The Kaplan-Meier method was used to estimate the cumulative incidences of recurrent stroke among subgroups. Independent risk factors and their interactions with recurrent stroke were identified by uni- and multi-variate Cox regression analysis with the baseline clinical characteristics.

Compared with the non-recurrence group, patients in the recurrence group were older with higher level of fasting plasma glucose and Lg Hcy, and higher proportion of previous history of diabetes mellitus and atrial fibrillation (P<0.05). Subgroup analysis showed patients with diabetes mellitus, atrial fibrillation, age ≥60 years fasting plasma glucose ≥7.0 mmol/L, and Hcy ≥15 μmol/L have a higher incidence of recurrence than other groups. Multi-variate Cox regression analysis showed that older patients, elevated Lg Hcy levels, diabetes mellitus and atrial fibrillation were independent risk factors for recurrent stroke in patients with stroke and hypertension. Furthermore, the interactions between Lg Hcy and other risk factors were statistically significant: diabetes mellitus, fasting plasma glucose and age.

Hcy is not only an independent risk factor, but also interactions with other risk factors on recurrent stroke in patients with stroke and hypertension.